MANILA, Philippines — The Economist’s Intelligence Unit, the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative late last month released their first Global Health Security index, which revealed a chilling reality: that no country in the world is “fully prepared for epidemics or pandemics,” with each one having gaps to address.
And although the Philippines on paper placed an above-average 53rd out of a total of 195 countries included in the study, the country also scored zero in a total of five health security indicators.
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This didn’t come as much of a surprise: the use of public data, after all, was a theme consistently repeated throughout the report, as GHS emphasized that this promotes accountability within the international community.
READ: Philippines ranks 53rd in epidemics preparedness study but global outlook not looking good
While it should be noted that the study’s methodology was limited to information that was made available for public consumption, null results should still be a cause for concern.
These failing grades come despite “health security” placing second in the government’s 12-point agenda in the country’s national security policy for 2017 through 2022. The document says that the government shall endeavor to prevent “the effects of infectious diseases as well as interdicting illegal and hazardous agents.”
Groups are calling the healthcare situation in the country a crisis of its own amid the underfunding of the Department of Health for 2020 on top of the outbreaks of infectious diseases like polio and African swine fever, and the public’s growing distrust in vaccines to reckon with.
This all comes as the Department of Health braces to roll out Universal Health Care in 2020.
Linking public health and security authorities
Listed under the “Response” category, the study outlines that public health and public security need to be linked to counter potential bioterrorism attacks or any other “deliberate biological event.”
GHS says that in the Philippines, any “coordinated plan to respond to biological threats” linking the Health department and the Department of National Defense remains to be publicly documented.
This comes despite the country’s hosting of an international conference on Global Terrorism and Chemical, Biological, Radiological, and Nuclear explosives and its participation in a similar conference on bioterrorism under the ASEAN Regional Forum.
Although not explicitly mentioned in the study, the mention of public health and security authorities in the same breath for many brings to mind the ongoing war on drugs, which has often been called a public health catastrophe.
"Having created enough [awareness] about it, we will now enter the second phase of the drug situation," then-presidential spokesman Ernesto Abella said in an interview with CNN Philippines in 2016.
"It's now shifted from a national security issue more into a public health issue."
Despite this acknowledged shift in approach, UN High Commissioner for Human Rights Michelle Bachelet in 2019 again called on President Rofrigo Duterte to take on a more "public health approach” in combating illegal drugs. Vice President Leni Robredo, too, echoed this call in October that year.
Three years later, the death toll of the war on drugs has since ballooned to 12,000 lives lost according to the Human Rights Watch.
According to March data from the Philippine Drug Enforcement Agency, the latest data on its website, at least 5,375 "drug personalities" have been killed since July 2016.
Communication with healthcare workers during public health emergency
Coalition for People's Right to Health co-convenor Josh San Pedro told Philstar.com in an online interview that the state of healthcare and the ongoing outbreaks reveal the state of communications among healthcare workers.
San Pedro pointed to “political devolution, geographic factors, underdeveloped telehealth systems” as some of the symptoms of the larger problem of “a fragmented health system,” calling the programs addressing African swine flu “disjointed.”
READ: African swine fever is now in the Philippines. Should you be alarmed?
“The reality is that access to healthcare in the country is still far from ideal,” San Pedro said. “Only 43% of barangays have a functional [barangay] health station [or] center, and the ratios of health workers to the population is overwhelming.”
WHO recommends a ratio of at least 45 health workers per 10,000 persons in a population. In the Philippines, the ratio stands at only 19 for every 10,000.
Dual-use research and culture of responsible science
The Economist Intelligence Unit claims that “there is no public evidence that the Philippines has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens and toxins.”
According to the 2018 WHO joint external evaluation, though, there exists “strong commitment” in the country to “academic research” in the field of biosafety.
The evaluation also acknowledges that institutions such as the University of the Philippines have established committees for “reviewing and approving research proposals.” However, no research initiatives were mentioned.
San Pedro pointed out that the focus of the study was more in line with first-world standards of health security and was geared towards pandemics and bioterror, something that was not as applicable in the Philippines as in more developed countries.
“How can we think about bioterrorism when poverty is the one wreaking havoc on our populace with these infectious pathogens?” he asked.
“Most of our pathogen research is hardly for weaponizing or bioterrorism [since] it's mostly towards our own infectious diseases: tuberculosis, dengue, schistosomiasis,” San Pedro added. “[But] our [pathogens] do have pandemic potential.”
“We are hardly secured from our own health hazards and risks, what more from external threats?”
Biosafety
The Biosafety indicator asked, “Does the country have in place national biosafety legislation and/or regulations?” and “Is there an established agency responsible for the enforcement of biosafety legislation and regulations?”
Issued in 2006, Executive Order No. 514 sought to establish the National Biosafety Framework and strengthen the National Committee on Biosafety of the Philippines, declaring as a matter of State policy the promotion of “safe and responsible use of modern biotechnology.”
Sure enough, while there are bodies in place to promote biosafety in the archipelago, the explicit enforcement and safeguarding of existing and already thin regulations has yet to be mentioned.
Science and Technology Secretary Fortunato de la Peña has himself admitted in the Fourth National Report Under the Cartagena Protocol on Biosafety that although regulations and guidelines were in place, these were “not legislated but [instead took] the form of Executive Issuances from the Office of the President.”
According to a briefer by the Department of Environment and Natural Resources, the Cartagena Protocol to the Convention on Biological Diversity is an international agreement listing guidelines for the usage and transport of living modified organisms "resulting from modern biotechnology that may have adverse effects on biological diversity, taking also into account risks to human health.” The Philippines is a listed party of the protocol and has been since October 2006.
GHS in their report pointed out that while the Philippines did carry out Confidence Building Measures in 2017 and 2018, access to both reports was restricted to the public. Thus, it remains to be seen if either of these measures contain information on the administration’s approach with regards to biosafety.
This portion also asks if the country requires biosafety training, “using a standardised, required approach [for] personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.”
The WHO 2018 joint external evaluation points out that RITM “has comprehensive institutional manuals and training programmes for biosafety and biosecurity,” although nothing is said about whether these measures are required.
Joint External Evaluations and Performance of Veterinary Services
According to the report’s criteria, JEE, or joint external evaluations, are any published precursor external evaluation such as the Global Health Security Agenda pilot external assessment.
The report goes on to say that while the country had already conducted a JEE from September 9-14, 2018, “its full report has not yet been published by the World Health Organization.” However, since the GHS last gathered data for the study in December 2018, the JEE has since been made available on the WHO website in September 2019.
The evaluation admits that “the Philippines has made good progress in implementing the provisions of the IHR.”
Moving on to the second portion, GHS asks: Has the country completed and published a Performance of Veterinary Services (PVS) assessment in the last five years? Its conclusion shares the same beat as the four previous zeroes: “Although [the] Philippines has conducted multiple [PVS] gap analysis missions, there is no evidence of a published report.”
“I think it's safe to say that veterinary services in this nation [are] not too strong, especially in working with larger health programs,” San Pedro admitted.
A matter of policy
Even the JEE notes that “[w]hile the Philippines has developed capabilities in various programme areas for public health emergency preparedness and response, there are still challenges in achieving a harmonized approach for implementation of the IHR.”
One problem that the study implicitly points to is freedom of information, as most of the zero-marks in the study were the direct result of a lack of documentation. “[W]e have such a big problem on publicly available data lalo sa health,” San Pedro said.
In the same way as the GHS, WHO also contended that the agenda of health security could and should be forwarded as a matter of state policy. Where WHO recommended that the government “Enhance high-level political commitment and accountability at all levels to advance implementation of [international health regulations], with adequate resourcing and engagement of all relevant sectors,” the GHS report, too, asserted that “political will is needed to save lives and build a safer and more secure world.”
For San Pedro, the factors affected by governance can make all the difference. “Some solutions fall short because we sometimes fail to take into account the social determinants of such diseases, namely poverty, poor housing, unemployment, and lack of food security,” he said.